Practice does not seem to be a feasible career option for most Ayurveda graduates. For a few idealists who consider this option, the hardships awaiting them are many. Despite the publicity campaigns to promote Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH), the fact is that there is a trust-deficit in these systems. For understandable reasons, Ayurveda is not the medical system of first choice for many people. “(Even) Ayurveda practitioners don’t seem to trust it fully,” Prime Minister Narendra Modi had noted in his speech at the sixth World Ayurveda Congress, in November 2014.
A scepticism that has some basis
There is widespread scepticism in the public mind about the soundness of Ayurvedic theories and the fruitfulness of its practices. This scepticism is not altogether baseless. The Ayurveda establishment has failed to keep pace with the intellectual and scientific advances of the times. Archaic theories that are apt to arouse suspicion in the minds of educated patients are peddled as sophisticated dogmas. Treatments are made to escape straightforward experimental scrutiny because of their supposed rootedness in such theories. When theories are kept mystified, using them to downplay the demands for experimental verification of practices becomes rather easy. Thus, a major reason for the trust-deficit in Ayurveda is its diminished evidence-based quality.
That Ayurveda treatments are slow to heal is another common view that characterises the public image of Ayurveda. This view also warrants a careful study.
Ayurveda’s thrust is on patient benefit and not merely on patient gratification. Real patient benefit would be sustainable as opposed to patient gratification which is momentary. Sustainability of treatments requires a gradual transition from illness to wellness. Sudden relief is deemed superficial and temporary. There is enough material in medical literature today to substantiate the prudence of this approach — at least, in principle. The popular view that Ayurvedic treatments are slow to heal is thus a half-truth. It can be corrected by appropriate patient education.
A practitioner’s ordeal
A novice who enters the field of Ayurvedic practice would be greeted with these difficult realities of public perception. As if this were not enough, he would soon discover that what has been generously handed over to him in his college training is a huge corpus of ancient medical wisdom, where only a part is practically usable. Given that Ayurveda does not have a vibrant ecosystem of science and research, the poor practitioner has to depend on himself to discover treatments and approaches that actually work. Sifting the usable parts from the obsolete ones requires prior experience, a knowledge of practice trends, and of course, a robust common sense. The process involves a lot of trial and error with patients and predictably leads to an erosion of the practitioner’s reputation.
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The practitioner’s ordeal does not end here. After he arrives at a rough understanding of the conditions in which his treatments are likely to work, it would become clear that Ayurveda can be used safely and efficaciously only in about 60%-70% of primary-care illnesses. For the rest, patient interest would necessitate complementing Ayurveda with modern medicine. Most States prohibit the practice of modern medicine by Ayurveda graduates and, consequently, the practitioner finds himself crippled again. Fewer footfalls in his clinic would be the sad consequence. At this stage, the gratitude of loyal patients alongside a few unusual recoveries remain the sole incentives that keep him alive as a practitioner.
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Even as a conscientious Ayurveda physician grapples with all these hardships, practitioners resorting to gimmickry and publicity have a field day. Using regular newspaper columns, television shows, and social media sites, they entrap gullible patients. The reticent counsels of decent Ayurveda physicians often get drowned in the cacophony of tall claims made by these charlatans. By supporting such gimmicks as “Ayurvedic astrology,” the AYUSH establishment also implicitly lends support to their ‘charlatanry’.
Focus on primary care
Appropriate policy-making can solve a lot of these problems that well-meaning Ayurveda practitioners face. Primary-care doctors are becoming an endangered species in India’s health-care system. Rejuvenating primary care is a sine qua non if a country is to secure the health of its citizens. Ayurveda graduates can contribute enormously towards this rejuvenation if trained properly.
A proper training of Ayurveda graduates with a view to make them good primary-care doctors would involve two preparatory exercises. One, a vigorous evidence-based appraisal of Ayurvedic theories and practices in order to sift the usable from the obsolete; and two, a statutory decision to allow Ayurveda graduates to practise modern medicine in stipulated primary care areas. These are two reforms that would help create a workforce that can function effectively to meet the primary health-care needs of both urban and rural India. Ayurveda, science, and public welfare all stand to gain. What is needed is sincerity, straight-thinking, and some adventurism on the part of stakeholders.
G.L. Krishna is an Ayurveda physician. He is a Homi Bhabha Fellow and also a visiting scholar at the Indian Institute of Science, Bengaluru. E-mail: email@example.com